Hemiplegic Stroke Patients Research Articles

A cross-sectional study of the impact of stigma on quality of life in hemiplegic stroke patients following suicide attempts in nursing homes

To analyze the factors affecting stigma and quality of life in hemiplegic stroke patients following suicide attempts in nursing homes and to provide a theoretical basis for developing interventions in clinical care. General demographic information, the Stigma Scale for Chronic Illness (SSCI), and the Quality of Life Scale (SF-36) were used to investigate 259 patients with hemiplegia after stroke following nursing home suicide from January to April 2024. Univariate statistical analyses were performed to assess the impact of potential determinants on quality of life. Multiple regression models and stratified analyses with smoothed curve fitting were used for further evaluation. Multiple regression modeling showed that the factors influencing the quality of life in hemiplegic stroke patients following suicide attempts in nursing homes were stigma, Age, marital status, education, type of occupation, monthly household income, and duration of illness. The level of quality of life before unadjusted variables was strongly associated with high school and college education (β = 11.9, 95% CI: 8.2–15.6; P < 0.001), (β = 13.1, 95% CI: 9.2 -16.9; P < 0.001). After adjusting for confounders such as marital status (Married, Unmarried), Age (< 30, 30–40, 40–50, > 50) (β = 8.1, 95% CI: 4 .6–11.6; P < 0.0001). (β = 9.5, 95% CI: 6.0–13.1;P < 0.0001), the results were not significantly different. Curve fitting revealed threshold nonlinear associations between intrinsic and extrinsic stigma and quality of life, with quality of life decreasing as stigma increased. Conclusion Stigma is negatively correlated with the level of quality of life in hemiplegic stroke patients following suicide attempts in nursing homes. Different demographic profiles moderated patients’ quality of life levels, and effective psychological intervention strategies should be used to improve patients’ quality of life.

Immediate Effects of Two Different Methods of Trunk Elastic Taping on Pelvic Inclination, Trunk Impairment, Balance, and Gait in Stroke Patients.

Background and Objectives: Stroke patients often experience changes in their pelvic tilt, trunk impairments and decreased gait and balance. While various therapeutic interventions have been attempted to improve these symptoms, there is a need for interventions that are easy to apply and reduce the physical labor of physical and occupational therapists. We aimed to investigate the immediate effects of two different methods of trunk elastic taping on the pelvic inclination, trunk impairment, balance, and gait in chronic stroke patients. Materials and Methods: We performed a single-blind randomized controlled trial involving 45 patients with chronic stroke. Participants were randomly assigned to one of three groups: forward rotation with posterior pelvic tilt taping (FRPPT, n = 14), backward rotation with posterior pelvic tilt taping (BRPPT, n = 14), or placebo taping (PT = 14). This study was conducted from December 2023 to January 2024. All the measurements were performed twice: before the intervention and immediately after the intervention. The pelvic inclination was assessed using the anterior pelvic tilt angle. The trunk impairment scale (TIS) was used to measure the trunk impairment. The balance and gait were evaluated using a force plate and walkway system. Results: The pelvic inclination was significantly different in the FRPPT and BRPPT groups compared to the PT group (p < 0.05, p < 0.001). The TIS and gait were significantly increased in the FRPPT group compared to the PT group (p < 0.05). The balance significantly improved in the FRPPT and BRPPT within groups (p < 0.05). Conclusions: Two different methods of posterior pelvic tilt taping improved the anterior pelvic tilt in chronic hemiplegic stroke patients compared with PT, and the FRPPT method also improved the trunk impairment and gait. Therefore, posterior pelvic tilt taping can be used as an intervention with immediate effect.

Effect of Whole-Body Vibration Versus Rhythmic Auditory Stimulation on Spasticity, Balance, and Lower Limb Motor Function in Hemiplegic Stroke Patients

Background: Stroke can lead to spasticity, balance impairments, and lower limb motor dysfunction. Whole-body vibration (WBV) and rhythmic auditory stimulation (RAS) are two therapeutic interventions that may address these deficits.Objective: To compare the effects of WBV and RAS on spasticity, balance, and lower limb motor function in hemiplegic stroke patients.Methods: A single-blinded, randomized controlled trial was conducted with 104 chronic hemiplegic stroke patients, divided into two groups: Group A (WBV) and Group B (RAS). WBV was applied using a vibration platform at 30-40 Hz for 3-minute sessions, 3 days/week for 4 weeks. RAS involved 90-minute sessions of music-based exercises, incorporating rhythmic cues and conventional therapy, 3 days/week for 4 weeks. Spasticity, balance, and motor function were assessed using the Modified Ashworth Scale, Berg Balance Scale, and Fugl-Meyer Assessment, respectively. Data were analyzed using SPSS version 27.Results: Group A showed greater improvements in spasticity (MAS: 1.2±0.4 vs. 2.6±0.3), balance (BBS: 49±5 vs. 43±5), and motor function (FMA: 29±5 vs. 18.5±5) compared to Group B (p&lt;0.05).Conclusion: WBV is more effective than RAS in improving spasticity, balance, and motor function in chronic hemiplegic stroke patients.

Immediate effects of insoles applied to the sound side lower extremity of patients with chronic hemiplegia during walking.

Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living. This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia. Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1 cm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System. Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (p < 0.05), whereas step time significantly increased (p < 0.05). The swing phase of the affected sidelower extremities significantly increased (p < 0.05), and the stance phase significantly decreased (p < 0.05). Double-support unloading phase (pre-swing phase) significantly increased (p < 0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (p < 0.05). Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.

Effects of acupuncture combined with trunk strengthening training on balance and gait abilities in stroke hemiplegic patients.

This study aimed to observe the effects of acupuncture combined with trunk strengthening training on balance and gait abilities in stroke hemiplegic patients. Sixty stroke hemiplegic patients were selected and randomly divided into a treatment group and a control group, with 30 patients in each group. The control group received conventional rehabilitation training and trunk strengthening exercises, while the treatment group received acupuncture in addition to the same interventions. Before and after 8 weeks of treatment, patients were assessed using the Holden Functional Ambulation Categories and Berg Balance Scale, and measurements were taken for step length, step width, and gait speed. Prior to treatment, there were no significant differences in Holden scores, Berg scores, step length, step width, or gait speed between the 2 groups (P > .05). After 8 weeks of treatment, significant improvements were observed in the aforementioned parameters in both groups (P < .05), with the acupuncture group showing significantly greater improvement compared to the control group (P < .05). Acupuncture combined with trunk strengthening training can significantly improve balance and gait impairments in stroke hemiplegic patients.

Effectiveness of Relaxation and Respiratory Exercise on Sleep Quality, Depression and Spasticity in Hemiplegic Stroke Patients: Preliminary Findings

Effectiveness of Relaxation and Respiratory Exercise on Sleep Quality, Depression and Spasticity in Hemiplegic Stroke Patients: Preliminary Findings

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance.

A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

A Novel Induction-Type Pressure Sensor based on Magneto-Stress Impedance and Magnetoelastic Coupling Effect for Monitoring Hand Rehabilitation.

Visualization of training effectiveness is critical to patients' confidence and eventual rehabilitation. Here, an innovative magnetoinductive pressure sensor is proposed for monitoring hand rehabilitation in stroke hemiplegic patients. It couples the giant magneto and stress-impedance effects of a square spiral amorphous wire with the giant magnetoelastic effect of a polymer magnet (NdFeB@PDMS). The addition of the magnetoelastic layer results in a sensitivity improvement of 178%, a wide sensing range (up to 1 MPa), fast response/recovery times (40 ms), and excellent mechanical robustness (over 15 000 cycles). Further integration with an LC oscillation circuit enables frequency adjustment into the MHz range resulting in a sensitivity of 6.6% kPa-1 and outstanding linearity (R2 = 0.99717) over a stress range of up to 100 kPa. When attached to a commercial split-fingerboard, the sensor is capable of dynamically monitoring the force in each finger, providing a reading of the rehabilitation process. Unlike conventional inductive sensors, the sensor is based on an inductive force-responsive material (amorphous wire), which significantly boosts the sensitivity. The approach also demonstrates the potential of magnetoelasticity in static pressure sensing, which is highly sensitive to dynamic pressure only through electromagnetic induction. This makes it more suitable for long-term and continuous human health monitoring.

Motor imagery therapy improved upper limb motor function in stroke patients with hemiplegia by increasing functional connectivity of sensorimotor and cognitive networks.

Motor imagery therapy (MIT) showed positive effects on upper limbs motor function. However, the mechanism by which MIT improves upper limb motor function is not fully understood. Therefore, our purpose was to investigate the changes in functional connectivity (FC) within and outside the sensorimotor network (SMN) induced by MIT associated with improvement in upper limb motor function in stroke patients. A total of 26 hemiplegic stroke patients were randomly divided into MIT (n = 13) and control (n = 13) groups. Fugl-Meyer Assessment Upper Extremity Scale (FMA-UL), Modified Barthel Index (MBI) and resting-state functional magnetic resonance imaging (rs-fMRI) were evaluated in the two groups before treatment and 4 weeks after treatment. The efficacy of MIT on motor function improvement in stroke patients with hemiplegia was evaluated by comparing the FMA-UL and MBI scores before and after treatment in the two groups. Furthermore, the FC within the SMN and between the SMN and the whole brain was measured and compared before and after different treatment methods in stroke patients. The correlation analysis between the improvement of upper limbs motor function and changes in FC within the SMN and between the SMN and the whole brain was examined. The FCs between ipsilesional primary motor cortex (M1.I) and contralateral supplementary motor area (SMA.C), M1.I and ipsilesional SMA (SMA.I), and SMA.C and contralateral dorsolateral premotor cortex (DLPM.C) significantly increased in the control group but decreased in the MIT group; while the FC between SMA.C and contralateral primary somatosensory cortex (S1.C) significantly increased in the control group but showed no significant difference in the MIT group. The FCs between M1.I and the ipsilesional hippocampal gyrus and ipsilesional middle frontal gyrus significantly decreased in the control group but increased in the MIT group; while the FC in the contralateral anterior cingulate cortex significantly increased in the MIT group but there was no significant difference in the control group. The results of the correlation analysis showed that the differences in abnormal intra-FCs within the SMN negatively correlated with the differences in FMA and MBI, and the difference in abnormal inter-FCs of the SMN positively correlated with the differences in FMA and MBI. MIT can improve upper limb motor function and daily activities of stroke patients, and the improvement effect of conventional rehabilitation therapy (CRT) combined with MIT is significantly higher than that of CRT alone. CRT may improve the upper limb motor function of stroke patients with hemiplegia mainly through the functional reorganization between SMN, while MIT may mainly increase the interaction between SMN and other brain networks.

Gait Variability and its Relationship to Functional Mobility in Hemiparetic Stroke

Background: Stroke remains a leading cause of long-term disability worldwide, with hemiplegia being one of the most common outcomes, significantly impairing gait and functional mobility. The integration of sensory stimulation techniques into rehabilitation practices offers a promising avenue for enhancing recovery outcomes in hemiplegic stroke survivors. Objective: This study aimed to investigate the effectiveness of auditory and visual sensory stimulation on improving gait parameters and functional mobility in hemiplegic stroke patients. Methods: Conducted at Mayo Hospital, Lahore, this analytical cross-sectional study involved 24 stroke survivors with hemiplegia, randomly assigned to two intervention groups. Inclusion criteria included a Modified Ashworth Scale score of 1 to 1+ and a Mini-Mental State Examination score of ≥25. One group received auditory feedback gait training (AFGT) with smart insoles, while the other engaged in sit-to-stand training with visual feedback using a Wii Balance Board, alongside conventional rehabilitation therapies. The interventions lasted four weeks, with assessments conducted pre and post-intervention. Outcome measures included the Dynamic Gait Index (DGI), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), and various gait parameters. Statistical analysis was performed using SPSS version 25. Results: Post-intervention, the study observed significant improvements in DGI (mean increase: 3.5 points, p&lt;0.01), FMA-LE scores (mean increase: 10 points, p&lt;0.01), and enhanced gait parameters including step length and stride length (p&lt;0.05). The group receiving AFGT with smart insoles showed notable improvements in spatiotemporal gait parameters and balance compared to the control group, indicating the efficacy of sensory feedback in rehabilitation. Conclusion: The study demonstrates that incorporating auditory and visual feedback into rehabilitation regimens can significantly improve gait dynamics and functional mobility in hemiplegic stroke patients. These findings suggest the potential for sensory stimulation techniques to enhance the effectiveness of stroke rehabilitation, advocating for their integration into standard care practices.

Effects of Task-Oriented and Strength Training on Upper Limb Recovery in Hemiplegic Stroke Patients

Effects of Task-Oriented and Strength Training on Upper Limb Recovery in Hemiplegic Stroke Patients

Analyzing the Combination Effects of Repetitive Transcranial Magnetic Stimulation and Motor Control Training on Balance Function and Gait in Patients with Stroke-Induced Hemiplegia

Objective: To analyze the effects of repetitive transcranial magnetic stimulation combined with motor control training on the treatment of stroke-induced hemiplegia, specifically focusing on the impact on patients’ balance functionand gait. Methods: Fifty-two cases of hemiplegic stroke patients were randomly divided into two groups, 26 in the control group and 26 in the observation group, using computer-generated random grouping. All participants underwent conventional treatment and rehabilitation training. In addition to these, the control group received repetitive transcranialmagnetic pseudo-stimulation therapy + motor control training, while the observation group received repetitive transcranial magnetic stimulation therapy + motor control training. The balance function and gait parameters of both groups were compared before and after the interventions and assessed the satisfaction of the interventions in both groups. Results: Before the invention, there were no significant differences in balance function scores and each gait parameter between the two groups (P &gt; 0.05). However, after the intervention, the observation group showed higher balance function scores compared to the control group (P &lt; 0.05). The observation group also exhibited higher step speed and step frequency, longer step length, and a higher overall satisfaction level with the intervention compared to the control group (P &lt; 0.05). Conclusion: The combination of repetitive transcranial magnetic stimulation and motor control training in the treatment of stroke-induced hemiplegia has demonstrated positive effects. It not only improves the patient’s balance function and gait but also contributes to overall physical rehabilitation.

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study.

Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.

Feasibility of Sarcopenia Diagnosis Using Stimulated Muscle Contraction Signal in Hemiplegic Stroke Patients.

Sarcopenia, a condition characterized by muscle weakness and mass loss, poses significant risks of accidents and complications. Traditional diagnostic methods often rely on physical function measurements like handgrip strength which can be challenging for affected patients, including those with stroke. To address these challenges, we propose a novel sarcopenia diagnosis model utilizing stimulated muscle contraction signals captured via wearable devices. Our approach achieved impressive results, with an accuracy of 93% and 100% in sarcopenia classification for male and female stroke patients, respectively. These findings underscore the significance of our method in diagnosing sarcopenia among stroke patients, offering a non-invasive and accessible solution.

Sarcopenia Diagnostic Technique Based on Artificial Intelligence Using Bio-signal of Neuromuscular System: A Proof-of-Concept Study.

In this paper, we propose an artificial intelligence (AI)-based sarcopenia diagnostic technique for stroke patients utilizing bio-signals from the neuromuscular system. Handgrip, skeletal muscle mass index, and gait speed are prerequisite components for sarcopenia diagnoses. However, measurement of these parameters is often challenging for most hemiplegic stroke patients. For these reasons, there is an imperative need to develop a sarcopenia diagnostic technique that requires minimal volitional participation but nevertheless still assesses the muscle changes related to sarcopenia. The proposed AI diagnostic technique collects motor unit responses from stroke patients in a resting state via stimulated muscle contraction signals (SMCSs) recorded from surface electromyography while applying electrical stimulation to the muscle. For this study, we extracted features from SMCS collected from stroke patients and trained our AI model for sarcopenia diagnosis. We validated the performance of the trained AI models for each gender against other diagnostic parameters. The accuracy of the AI sarcopenia model was 96%, and 95% for male and females, respectively. Through these results, we were able to provide preliminary proof that SMCS could be a potential surrogate biomarker to reflect sarcopenia in stroke patients.

Muscle Strength Performance Characteristics of the Hip Abductor Muscles of Hemiplegic Stroke Patients: Relationship between Dynamic Characteristics and Performance

Muscle Strength Performance Characteristics of the Hip Abductor Muscles of Hemiplegic Stroke Patients: Relationship between Dynamic Characteristics and Performance

The impact of cycling exercise on motor and functional recovery of patients in acute and subacute stroke phase

Introduction/Objective. Neurological impairment and immobility in stroke patients can lead to numerous complications. This study aimed to evaluate the effect of cycling exercises with visual feedback combined with conventional rehabilitation on neurological and motor recovery, balance, walking speed and endurance, and activities of daily living (ADL) in patients after acute and subacute stroke. Methods. A randomized prospective controlled trial was applied to this research. One hundred and twenty-seven hemiplegic stroke patients who received in-hospital rehabilitation were randomly assigned into two groups. Both groups received conventional rehabilitation treatment. The experimental group had an extra 30 minutes of cycling exercises for the upper and lower extremities on a stationary ergocycle MOTOmed muvi. Both groups? neurological status, upper and lower limb function, independence in ADL, balance, walking speed, and endurance were observed before and after the rehabilitation treatment. Outcome measures used were the National Institute of Health Stroke Scale (NIHSS), the modified Ashworth scale (MAS), the Brunnstrom Motor Evaluation Scale (BMES), upper and lower Fugl-Meyer assessment (FMA), the Barthel index (BI), the Berg Balance Scale (BBS), the six-minute walk test (6MWT) and the Timed Up and Go test (TUG). Results. The neurological recovery on the NIHSS scale, spasticity of the knee extensor measured by the MAS, the BMES and FMA-LE subscale for the affected leg, and the 6MWT presented more significant improvement in the experimental group than in the control group after the treatment (p &lt; 0.05 for all three analyses). Conclusion. Cycling exercises with visual feedback combined with conventional rehabilitation could promote neurological recovery and improve the motor function of the affected leg and walking speed in patients recuperating after acute and subacute stroke.

Robotic exoskeleton-assisted walking rehabilitation for stroke patients: a bibliometric and visual analysis.

This study aimed to conduct a bibliometric analysis of the literature on exoskeleton robot assisted walking rehabilitation for stroke patients in the Web of Science Core Collection over the past decade. Retrieved literature on exoskeleton robot assisted gait training for stroke hemiplegic patients from the Web of Science Core Collection from 1 January 2014 to 31 January 2024. The search method was topic search, and the types of documents were "article, meeting abstract, review article, early access." CiteSpace was used to analyze the search results from countries, institutions, keywords, cited references and cited authors. A total of 1,349 articles were retrieved, and 1,034 were ultimately included for visualization analysis. The annual publication volume showed an upward trend, with countries, institutions, and authors from Europe and America in a leading position. The core literature was also published by authors from European and American countries. The keywords were divided into 8 clusters: # 0 soft robotic exit, # 1 robot assisted gain training, # 2 multiple scales, # 3 magnetic rheological brake, # 4 test retest reliability, # 5 electromechanical assisted training, # 6 cerebra salary, and # 7 slow gain. The early research direction focused on the development of exoskeleton robots, verifying their reliability and feasibility. Later, the focus was on the combination of exoskeleton robot with machine learning and other technologies, rehabilitation costs, and patient quality of life. This study provides a visual display of the research status, development trends, and research hotspots, which helps researchers in this field to grasp the research hotspots and choose future research directions.

The Effect of Robot-Assisted Gait Training with Rhythmic Auditory Stimulation on Lower Limb Function, Balance and Gait in Hemiplegic Stroke Patients

The Effect of Robot-Assisted Gait Training with Rhythmic Auditory Stimulation on Lower Limb Function, Balance and Gait in Hemiplegic Stroke Patients

Assessing the Impact of Posterior Leaf Spring Ankle Foot Orthosis on Knee Joint of Hemiplegic Stroke Patients Through Software Gait Analysis

Background: Ankle Foot Orthoses (AFO) is mostly advised for a stroke patient who is complicated with plantarflexion deformity, to support and improve the alignments of the feet for reducing knee joint extension and promoting hip joint extension through stance-phase.&#x0D; Objective: To provide deeper knowledge using software gait analysis for the biomechanical effects of PLS AFO for stroke patients.&#x0D; Patients and Methods: We divided 42 participants into 3 groups (the first and second groups were 28 stroke participants that used AFO and with OUT-AFO and the third group was 14 normal participants without deformity. All participants walk 10 meters in a straight line for the same time their gait was captured at Comfortable Walking Speed (CWS). Temporal-spatial and kinematic parameters of the knee joint were compared in the study.&#x0D; Results: The PLS AFO showed improvement in knee ROM in the AFO condition that has better knee flexion in the early stance (from 8.16 to 16.24 degrees in the AFO condition), a huge increase in the late stance of knee extension (from 0.16 to 3.82 degrees) and better knee flexion than the barefoot condition in the swing flexion (from 26.1 to 39.78 degrees). Also, the mean Time Up and Go (TUG) identically decreased in stroke participants (from 36.04 s in OUT-AFO to 22.6 s in AFO condition).&#x0D; Conclusion: In this study, we showed that using a PLS AFO can be beneficial for improving knee ROM and progress walking speed, gait symmetry, balance, and reducing the risk of falls.